title: Validation of a Modified-Multidimensional Prognostic Index (m-MPI) including the Mini Nutritional Assessment Short-Form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients.
abstract: BACKGROUND
  The mortality prediction represents a key factor in the managing of elderly hospitalized patients. Since in older subjects mortality results from a combination of biological, functional, nutritional, psychological and environmental factors, a Multidimensional Prognostic Index (MPI) that predict short- and long-term mortality based on a standardized comprehensive geriatric assessment (CGA) has recently been developed and validated.
  
  
  OBJECTIVE
  This study compares the accuracy in predicting the mortality of the MPI with a modified version of the MPI (m-MPI) that included the Mini Nutritional Assessment-Short Form (MNA-SF) instead of the standard MNA.
  
  
  METHODS
  This prospective study with a one-year follow-up included 4088 hospitalized patients aged 65 years and older. A standardized CGA that included information on functional (Activities of Daily Living, ADL and Instrumental-ADL), cognitive (Short Portable Mental Status Questionnaire), risk of pressure sore (Exton-Smith Scale), comorbidities (CIRS Index), medications, living status and nutritional status (MNA and MNA-SF) was used to calculate the MPI using a previously validated algorithm.
  
  
  RESULTS
  Higher MPI values were significantly associated with higher mortality rates with a close agreement between the estimated and the observed mortality both after 1-month (MPI1=2.8% versus m-MPI1=2.8%,p=0.946; MPI2=8.9% versus m-MPI2=9%,p=0.904; MPI3=21.9% versus m-MPI3=21.9,p=0.978) and 1-year of follow-up (MPI1=10.8% versus m-MPI1=10.5%,p=0.686; MPI2=27.3% versus m-MPI2=28%, p=0.495; MPI3=52.8% versus m-MPI3=52.7%,p=0.945). The estimated areas under the receiver operating characteristics (ROC) curves suggested a clinically negligible difference between the two indices.
  
  
  CONCLUSIONS
  The m-MPI is as sensitive as the MPI in stratifying hospitalized elderly patients into groups at varying risk of short- and long-term mortality, but with fewer items.
authors.affiliation: Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Sancarlo
authors.forename: G
authors.initials: G
authors.lastname: D'Onofrio
authors.forename: M
authors.initials: M
authors.lastname: Franceschi
authors.forename: C
authors.initials: C
authors.lastname: Scarcelli
authors.forename: V
authors.initials: V
authors.lastname: Niro
authors.forename: F
authors.initials: F
authors.lastname: Addante
authors.forename: M
authors.initials: M
authors.lastname: Copetti
authors.forename: L
authors.initials: L
authors.lastname: Ferrucci
authors.forename: L
authors.initials: L
authors.lastname: Fontana
authors.forename: A
authors.initials: A
authors.lastname: Pilotto
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008603:Mental Health; D015596:Nutrition Assessment; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011795:Surveys and Questionnaires / Q000592:standards*